J Korean Med Sci.  2010 Mar;25(3):485-488. 10.3346/jkms.2010.25.3.485.

Balloon Valvuloplasty for Neonatal Critical Pulmonary Valvar Stenosis with IVC Interruption: Pitfalls of the Transumbilical Approach

• Kim GB
• Bae EJ
• Noh CI

• KMID: 1778049
• DOI: http://doi.org/10.3346/jkms.2010.25.3.485

Abstract

Transcatheter balloon pulmonary valvuloplasty (BPV) is considered to be the treatment of choice for neonates with critical pulmonary valvar stenosis (PVS) or pulmonary valvar atresia with intact ventricular septum accompanied by reasonable right ventricular volume. The percutaneous femoral venous access is the most preferred route for BPV in most cardiac centers. We report herein the case of a newborn baby with critical PVS with inferior vena cava interruption, severe tricuspid regurgitation and a severely enlarged right atrium. We tried BPV through the transumbilical approach with difficulty, but he was successfully treated with the assistance of a coronary artery guiding catheter.

Keyword

Pulmonary Valve Stenosis; Umbilical Veins; Balloon Dilatation; Infant, Newborn

MeSH Terms

Catheterization/*methods
Echocardiography
Heart Defects, Congenital/surgery
Humans
Infant, Newborn
Infant, Newborn, Diseases/*surgery
Male
Pulmonary Atresia/*surgery
Treatment Outcome

Figure

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  Fig. 1 Changes in heart size before (A) and after (B) balloon pulmonary valvuloplasty. Marked cardiomegaly regressed nine months after successful valvuloplasty on chest radiography.

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  Fig. 2 Echocardiographic findings before balloon pulmonary valvuloplasty. Trans-thoracic echocardiograms showed a severely enlarged right atrium (RA), a relatively small right ventricle (RV) (A), a thickened tricuspid valve and a pinhole pulmonary valvar orifice with doming of leaflets (B). PV, pulmonary valve.

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  Fig. 3 Anteroposterior (A) and lateral (B) view of umbilical venous angiography. (A) Angiography of the umbilical vein (UV) showed a stenotic or nearly closing ductus venosus. (B) Catheter introduction to the right ventricular and right ventricular outlet tracts (RVOTs) was extremely difficult and very different from the transfemoral approach (thin dotted line) because posteriorly deviated sheath (thick dotted line) made the catheter easily go into patent foramen ovale (PFO) or coronary sinus (CS).

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  Fig. 4 Successful balloon valvuloplasty for pulmonary valvar stenosis. (A) Successful ballooning of a 3-mm diameter coronary balloon catheter with the assistance of a 5F right coronary artery guiding catheter formed a loop within the right atrium. (B) Sequential dilatation of pulmonary valve with an 8-mm diameter Ultra-thin (UT) balloon catheter.

Reference

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